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Liu G, Wang Y, Tian F, Chen W, Cui L, Jiang M, Zhang Y, Gao K, Su Y, Wang H. Quantitative EEG reactivity induced by electrical stimulation predicts good outcome in comatose patients after cardiac arrest. Ann Intensive Care 2024; 14:99. [PMID: 38935167 PMCID: PMC11211292 DOI: 10.1186/s13613-024-01339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND EEG reactivity is a predictor for neurological outcome in comatose patients after cardiac arrest (CA); however, its application is limited by variability in stimulus types and visual assessment. We aimed to evaluate the prognostic value of the quantitative analysis of EEG reactivity induced by standardized electrical stimulation and for early prognostication in this population. METHODS This prospective observational study recruited post-CA comatose patients in Xuanwu Hospital, Capital Medical University (Beijing, China) between January 2016 and June 2023. EEG reactivity to electrical or traditional pain stimulation was randomly performed via visual and quantitative analysis. Neurological outcome within 6 months was dichotomized as good (Cerebral Performance Categories, CPC 1-2) or poor (CPC 3-5). RESULTS Fifty-eight post-CA comatose patients were admitted, and 52 patients were included in the final analysis, of which 19 (36.5%) had good outcomes. EEG reactivity induced with the electrical stimulation had superior performance to the traditional pain stimulation for good outcome prediction (quantitative analysis: AUC 0.932 vs. 0.849, p = 0.048). When using the electrical stimulation, the AUC of EEG reactivity to predict good outcome by visual analysis was 0.838, increasing to 0.932 by quantitative analysis (p = 0.039). Comparing to the traditional pain stimulation by visual analysis, the AUC of EEG reactivity for good prognostication by the electrical stimulation with quantitative analysis was significantly improved (0.932 vs. 0.770, p = 0.004). CONCLUSIONS EEG reactivity induced by the standardized electrical stimulation in combination with quantitative analysis is a promising formula for post-CA comatose patients, with increased predictive accuracy.
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Affiliation(s)
- Gang Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Brain Injury Evaluation Quality Control Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Yuan Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Brain Injury Evaluation Quality Control Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Fei Tian
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Brain Injury Evaluation Quality Control Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Weibi Chen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Brain Injury Evaluation Quality Control Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Lili Cui
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Brain Injury Evaluation Quality Control Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Mengdi Jiang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Brain Injury Evaluation Quality Control Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Yan Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Brain Injury Evaluation Quality Control Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China
| | - Keming Gao
- Department of Psychiatry, Mood Disorders Program, University Hospitals Cleveland Medical Center/Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Yingying Su
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Brain Injury Evaluation Quality Control Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
| | - Hongxing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, National Brain Injury Evaluation Quality Control Center, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing, 100053, China.
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Hwang J, Cho SM, Geocadin R, Ritzl EK. Methods of Evaluating EEG Reactivity in Adult Intensive Care Units: A Review. J Clin Neurophysiol 2024:00004691-990000000-00133. [PMID: 38857365 DOI: 10.1097/wnp.0000000000001078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
PURPOSE EEG reactivity (EEG-R) has become widely used in intensive care units for diagnosing and prognosticating patients with disorders of consciousness. Despite efforts toward standardization, including the establishment of terminology for critical care EEG in 2012, the processes of testing and interpreting EEG-R remain inconsistent. METHODS A review was conducted on PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria consisted of articles published between January 2012, and November 2022, testing EEG-R on adult intensive care unit patients. Exclusion criteria included articles focused on highly specialized stimulation equipment or animal, basic science, or small case report studies. The Quality In Prognostic Studies tool was used to assess risk of bias. RESULTS One hundred and five articles were identified, with 26 variables collected for each. EEG-R testing varied greatly, including the number of stimuli (range: 1-8; 26 total described), stimulus length (range: 2-30 seconds), length between stimuli (range: 10 seconds-5 minutes), frequency of stimulus application (range: 1-9), frequency of EEG-R testing (range: 1-3 times daily), EEG electrodes (range: 4-64), personnel testing EEG-R (range: neurophysiologists to nonexperts), and sedation protocols (range: discontinuing all sedation to no attempt). EEG-R interpretation widely varied, including EEG-R definitions and grading scales, personnel interpreting EEG-R (range: EEG specialists to nonneurologists), use of quantitative methods, EEG filters, and time to detect EEG-R poststimulation (range: 1-30 seconds). CONCLUSIONS This study demonstrates the persistent heterogeneity of testing and interpreting EEG-R over the past decade, and contributing components were identified. Further many institutional efforts must be made toward standardization, focusing on the reproducibility and unification of these methods, and detailed documentation in the published literature.
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Affiliation(s)
- Jaeho Hwang
- Division of Epilepsy, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
| | - Sung-Min Cho
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine and Neurology, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.; and
| | - Romergryko Geocadin
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine and Neurology, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.; and
| | - Eva K Ritzl
- Division of Epilepsy, Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A
- Division of Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine and Neurology, Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.; and
- Division of Intraoperative Monitoring, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Vitt JR, Mainali S. Artificial Intelligence and Machine Learning Applications in Critically Ill Brain Injured Patients. Semin Neurol 2024; 44:342-356. [PMID: 38569520 DOI: 10.1055/s-0044-1785504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
The utilization of Artificial Intelligence (AI) and Machine Learning (ML) is paving the way for significant strides in patient diagnosis, treatment, and prognostication in neurocritical care. These technologies offer the potential to unravel complex patterns within vast datasets ranging from vast clinical data and EEG (electroencephalogram) readings to advanced cerebral imaging facilitating a more nuanced understanding of patient conditions. Despite their promise, the implementation of AI and ML faces substantial hurdles. Historical biases within training data, the challenge of interpreting multifaceted data streams, and the "black box" nature of ML algorithms present barriers to widespread clinical adoption. Moreover, ethical considerations around data privacy and the need for transparent, explainable models remain paramount to ensure trust and efficacy in clinical decision-making.This article reflects on the emergence of AI and ML as integral tools in neurocritical care, discussing their roles from the perspective of both their scientific promise and the associated challenges. We underscore the importance of extensive validation in diverse clinical settings to ensure the generalizability of ML models, particularly considering their potential to inform critical medical decisions such as withdrawal of life-sustaining therapies. Advancement in computational capabilities is essential for implementing ML in clinical settings, allowing for real-time analysis and decision support at the point of care. As AI and ML are poised to become commonplace in clinical practice, it is incumbent upon health care professionals to understand and oversee these technologies, ensuring they adhere to the highest safety standards and contribute to the realization of personalized medicine. This engagement will be pivotal in integrating AI and ML into patient care, optimizing outcomes in neurocritical care through informed and data-driven decision-making.
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Affiliation(s)
- Jeffrey R Vitt
- Department of Neurological Surgery, UC Davis Medical Center, Sacramento, California
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia
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Mathur R, Meyfroidt G, Robba C, Stevens RD. Neuromonitoring in the ICU - what, how and why? Curr Opin Crit Care 2024; 30:99-105. [PMID: 38441121 DOI: 10.1097/mcc.0000000000001138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW We selectively review emerging noninvasive neuromonitoring techniques and the evidence that supports their use in the ICU setting. The focus is on neuromonitoring research in patients with acute brain injury. RECENT FINDINGS Noninvasive intracranial pressure evaluation with optic nerve sheath diameter measurements, transcranial Doppler waveform analysis, or skull mechanical extensometer waveform recordings have potential safety and resource-intensity advantages when compared to standard invasive monitors, however each of these techniques has limitations. Quantitative electroencephalography can be applied for detection of cerebral ischemia and states of covert consciousness. Near-infrared spectroscopy may be leveraged for cerebral oxygenation and autoregulation computation. Automated quantitative pupillometry and heart rate variability analysis have been shown to have diagnostic and/or prognostic significance in selected subtypes of acute brain injury. Finally, artificial intelligence is likely to transform interpretation and deployment of neuromonitoring paradigms individually and when integrated in multimodal paradigms. SUMMARY The ability to detect brain dysfunction and injury in critically ill patients is being enriched thanks to remarkable advances in neuromonitoring data acquisition and analysis. Studies are needed to validate the accuracy and reliability of these new approaches, and their feasibility and implementation within existing intensive care workflows.
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Affiliation(s)
- Rohan Mathur
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Geert Meyfroidt
- Department of Intensive Care Medicine, University Hospitals Leuven, Belgium and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Belgium
| | - Chiara Robba
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate, Università degli Studi di Genova, Genova, Italy
| | - Robert D Stevens
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore MD, USA
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Frauscher B, Rossetti AO, Beniczky S. Recent advances in clinical electroencephalography. Curr Opin Neurol 2024; 37:134-140. [PMID: 38230652 DOI: 10.1097/wco.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
PURPOSE OF REVIEW Clinical electroencephalography (EEG) is a conservative medical field. This explains likely the significant gap between clinical practice and new research developments. This narrative review discusses possible causes of this discrepancy and how to circumvent them. More specifically, we summarize recent advances in three applications of clinical EEG: source imaging (ESI), high-frequency oscillations (HFOs) and EEG in critically ill patients. RECENT FINDINGS Recently published studies on ESI provide further evidence for the accuracy and clinical utility of this method in the multimodal presurgical evaluation of patients with drug-resistant focal epilepsy, and opened new possibilities for further improvement of the accuracy. HFOs have received much attention as a novel biomarker in epilepsy. However, recent studies questioned their clinical utility at the level of individual patients. We discuss the impediments, show up possible solutions and highlight the perspectives of future research in this field. EEG in the ICU has been one of the major driving forces in the development of clinical EEG. We review the achievements and the limitations in this field. SUMMARY This review will promote clinical implementation of recent advances in EEG, in the fields of ESI, HFOs and EEG in the intensive care.
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Affiliation(s)
- Birgit Frauscher
- Department of Neurology, Duke University Medical Center & Department of Biomedical Engineering, Duke Pratt School of Engineering, Durham, North Carolina, USA
| | - Andrea O Rossetti
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund
- Aarhus University Hospital, Aarhus, Denmark
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Qing K, Forgacs P, Schiff N. EEG Pattern With Spectral Analysis Can Prognosticate Good and Poor Neurologic Outcomes After Cardiac Arrest. J Clin Neurophysiol 2024; 41:236-244. [PMID: 36007069 PMCID: PMC9905375 DOI: 10.1097/wnp.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate the prognostic value of a simple stratification system of electroencephalographical (EEG) patterns and spectral types for patients after cardiac arrest. METHODS In this prospectively enrolled cohort, using manually selected EEG segments, patients after cardiac arrest were stratified into five independent EEG patterns (based on background continuity and burden of highly epileptiform discharges) and four independent power spectral types (based on the presence of frequency components). The primary outcome is cerebral performance category (CPC) at discharge. Results from multimodal prognostication testing were included for comparison. RESULTS Of a total of 72 patients, 6 had CPC 1-2 by discharge, all of whom had mostly continuous EEG background without highly epileptiform activity at day 3. However, for the same EEG background pattern at day 3, 19 patients were discharged at CPC 3 and 15 patients at CPC 4-5. After adding spectral analysis, overall sensitivity for predicting good outcomes (CPC 1-2) was 83.3% (95% confidence interval 35.9% to 99.6%) and specificity was 97.0% (89.5% to 99.6%). In this cohort, standard prognostication testing all yielded 100% specificity but low sensitivity, with imaging being the most sensitive at 54.1% (36.9% to 70.5%). CONCLUSIONS Adding spectral analysis to qualitative EEG analysis may further improve the diagnostic accuracy of EEG and may aid developing novel measures linked to good outcomes in postcardiac arrest coma.
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Affiliation(s)
- Kurt Qing
- New York-Presbyterian Weill Cornell Medical Center
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Chen CC, Massey SL, Kirschen MP, Yuan I, Padiyath A, Simpao AF, Tsui FR. Electroencephalogram-based machine learning models to predict neurologic outcome after cardiac arrest: A systematic review. Resuscitation 2024; 194:110049. [PMID: 37972682 PMCID: PMC11023717 DOI: 10.1016/j.resuscitation.2023.110049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
AIM OF THE REVIEW The primary aim of this systematic review was to investigate the most common electroencephalogram (EEG)-based machine learning (ML) model with the highest Area Under Receiver Operating Characteristic Curve (AUC) in two ML categories, conventional ML and Deep Neural Network (DNN), to predict the neurologic outcomes after cardiac arrest; the secondary aim was to investigate common EEG features applied to ML models. METHODS Systematic search of medical literature from PubMed and engineering literature from Compendex up to June 2, 2023. One reviewer screened studies that used EEG-based ML models to predict the neurologic outcomes after cardiac arrest. Four reviewers validated that the studies met selection criteria. Nine variables were manually extracted. The top-five common EEG features were calculated. We evaluated each study's risk of bias using the Quality in Prognosis Studies guideline. RESULTS Out of 351 identified studies, 17 studies met the inclusion criteria. Random Forest (RF) (n = 7) was the most common ML model in the conventional ML category (n = 11), followed by Convolutional Neural Network (CNN) (n = 4) in the DNN category (n = 6). The AUCs for RF ranged between 0.8 and 0.97, while CNN had AUCs between 0.7 and 0.92. The top-three commonly used EEG features were band power (n = 12), Shannon's Entropy (n = 11), burst-suppression ratio (n = 9). CONCLUSIONS RF and CNN were the two most common ML models with the highest AUCs for predicting the neurologic outcomes after cardiac arrest. Using a multimodal model that combines EEG features and electronic health record data may further improve prognostic performance.
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Affiliation(s)
- Chao-Chen Chen
- Tsui Laboratory, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA 19146, United States; Department of Bioengineering, University of Pennsylvania, 240 Skirkanich Hall, 210 S 33rd St, Philadelphia, PA 19104, United States
| | - Shavonne L Massey
- Department of Neurology and Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Matthew P Kirschen
- Department of Neurology and Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Ian Yuan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Asif Padiyath
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Allan F Simpao
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States
| | - Fuchiang Rich Tsui
- Tsui Laboratory, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA 19146, United States; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, United States; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, 423 Guardian Dr, Philadelphia, PA 19104, United States; Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, United States.
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Amorim E, Zheng WL, Ghassemi MM, Aghaeeaval M, Kandhare P, Karukonda V, Lee JW, Herman ST, Sivaraju A, Gaspard N, Hofmeijer J, van Putten MJAM, Sameni R, Reyna MA, Clifford GD, Westover MB. The International Cardiac Arrest Research Consortium Electroencephalography Database. Crit Care Med 2023; 51:1802-1811. [PMID: 37855659 PMCID: PMC10841086 DOI: 10.1097/ccm.0000000000006074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To develop the International Cardiac Arrest Research (I-CARE), a harmonized multicenter clinical and electroencephalography database for acute hypoxic-ischemic brain injury research involving patients with cardiac arrest. DESIGN Multicenter cohort, partly prospective and partly retrospective. SETTING Seven academic or teaching hospitals from the United States and Europe. PATIENTS Individuals 16 years old or older who were comatose after return of spontaneous circulation following a cardiac arrest who had continuous electroencephalography monitoring were included. INTERVENTIONS Not applicable. MEASUREMENTS AND MAIN RESULTS Clinical and electroencephalography data were harmonized and stored in a common Waveform Database-compatible format. Automated spike frequency, background continuity, and artifact detection on electroencephalography were calculated with 10-second resolution and summarized hourly. Neurologic outcome was determined at 3-6 months using the best Cerebral Performance Category (CPC) scale. This database includes clinical data and 56,676 hours (3.9 terabytes) of continuous electroencephalography data for 1,020 patients. Most patients died ( n = 603, 59%), 48 (5%) had severe neurologic disability (CPC 3 or 4), and 369 (36%) had good functional recovery (CPC 1-2). There is significant variability in mean electroencephalography recording duration depending on the neurologic outcome (range, 53-102 hr for CPC 1 and CPC 4, respectively). Epileptiform activity averaging 1 Hz or more in frequency for at least 1 hour was seen in 258 patients (25%) (19% for CPC 1-2 and 29% for CPC 3-5). Burst suppression was observed for at least 1 hour in 207 (56%) and 635 (97%) patients with CPC 1-2 and CPC 3-5, respectively. CONCLUSIONS The I-CARE consortium electroencephalography database provides a comprehensive real-world clinical and electroencephalography dataset for neurophysiology research of comatose patients after cardiac arrest. This dataset covers the spectrum of abnormal electroencephalography patterns after cardiac arrest, including epileptiform patterns and those in the ictal-interictal continuum.
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Affiliation(s)
- Edilberto Amorim
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wei-Long Zheng
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, CN
| | - Mohammad M. Ghassemi
- Department of Computer Science and Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Mahsa Aghaeeaval
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Pravinkumar Kandhare
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Vishnu Karukonda
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Jong Woo Lee
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Susan T. Herman
- Department of Neurology, Barrow Neurological Institute, Comprehensive Epilepsy Center, Phoenix, Arizona, USA
| | - Adithya Sivaraju
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nicolas Gaspard
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neurology, Universite Libre de Bruxelles, Brussels, Belgium
| | - Jeannette Hofmeijer
- Clinical Neurophysiology Group, University of Twente, Enschede, The Netherlands
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel J. A. M. van Putten
- Clinical Neurophysiology Group, University of Twente, Enschede, The Netherlands
- Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, The Netherlands
| | - Reza Sameni
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Matthew A. Reyna
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - M. Brandon Westover
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Sohn G, Kim SE. Measurement of thalamus and cortical damages in hypoxic ischemic encephalopathy. IBRO Neurosci Rep 2023; 15:179-185. [PMID: 37731916 PMCID: PMC10507579 DOI: 10.1016/j.ibneur.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
Background The thalamic gray-white matter ratios (GWRs) on CT and quantitative suppression ratios (SRs) of background activities on EEG may reflect damages in the thalamus and cerebral hemispheres in patients with hypoxic-ischemic encephalopathy (HIE). Methods The inclusion criteria were (1) cardiac arrest patients over the age of 20 years from March 2010 to March 2020, and (2) patients who had both EEG and brain CT within 7 days after cardiac arrest. The thalamic GWRs were semi-quantitatively measured by using the region of interest (ROI). SRs of background were analyzed with the installed software (Persyst® v13) in EEG machine. Results 175 patients were included among 686 patients with HIE and the thalamic GWRs of 168 patients were successfully measured. 155 patients (89 %) showed poor outcomes. The poor outcome group revealed not only higher SRs, but also lower thalamic GWRs. The thalamic GWRs showed a negative correlation to the SRs (ρ (rho) = -0.36, p < 0.0001 for right side, ρ (rho) = -0.31, p < 0.0001 for left side). The good outcome group showed neither beyond the cut-off values of thalamic GWRs nor SRs [40 % (59/148) VS 0 % (0/20) in right side, p = 0.0005 %, and 28 % (42/148) VS 0 % (0/20) in left side, p = 0.0061]. Conclusion The thalamic GWRs and SRs may reflect the damage in the thalamus and cerebral hemispheres in patients with HIE. Insults in the thalamocortical circuit (TCC) or the thalamus might be responsible for the poor outcome.
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Affiliation(s)
| | - Sung Eun Kim
- Correspondence to: Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan 48108, Republic of Korea.
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Ding X, Shen Z. Electroencephalography Prediction of Neurological Outcomes After Hypoxic-Ischemic Brain Injury: A Systematic Review and Meta-Analysis. Clin EEG Neurosci 2023:15500594231211105. [PMID: 37941351 DOI: 10.1177/15500594231211105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Background. Predicting neurological outcomes after hypoxic-ischemic brain injury (HIBI) is difficult. Objective. Electroencephalography (EEG) can identify acute and subacute brain abnormalities after hypoxic brain injury and predict HIBI recovery. We examined EEG's ability to predict neurologic outcomes following HIBI. Method. A PRISMA-compliant search was conducted in the Medline, Embase, Cochrane, and Central databases until January 2023. EEG-predicted neurological outcomes in HIBI patients were selected from relevant perspective and retrospective cohort studies. RevMan did meta-analysis, while QDAS2 assessed research quality. Results. Eleven studies with 3761 HIBI patients met the inclusion and exclusion criteria. We aggregated study-level estimates of sensitivity and specificity for EEG patterns determined a priori using random effect bivariate and univariate meta-analysis when appropriate. Positive indicators and anatomical area heterogeneity impacted prognosis accuracy. Funnel plots analyzed publication bias. Significant heterogeneity of greater than 80% was among the included studies with P < 0.001. The area under the curve was 0.94, the threshold effect was P < 0.001, and the sensitivity and specificity, with 95% confidence intervals, were 0.91 (0.84-0.99) and 0.86 (0.75-0.97). EEG detects status epilepticus and burst suppression with good sensitivity, specificity, and little probability of false-negative impairment result attribution. Study quality varied by domain, but patient flow and timing were well conducted in all. Conclusion. EEG can predict the outcome of HIBI with good prognostic accuracy, but more standardized cross-study protocols and descriptions of EEG patterns are needed to better evaluate its prognostic use for patients with HIBI.
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Affiliation(s)
- Xina Ding
- Department of Brain Function, Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
| | - Zhixiao Shen
- Department of Brain Function, Hospital of Nantong University, No. 20 Xisi Road, Chongchuan District, Nantong City, Jiangsu Province, 226001, China
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11
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Amorim E, Zheng WL, Ghassemi MM, Aghaeeaval M, Kandhare P, Karukonda V, Lee JW, Herman ST, Sivaraju A, Gaspard N, Hofmeijer J, van Putten MJAM, Sameni R, Reyna MA, Clifford GD, Westover MB. The International Cardiac Arrest Research (I-CARE) Consortium Electroencephalography Database. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.28.23294672. [PMID: 37693458 PMCID: PMC10491275 DOI: 10.1101/2023.08.28.23294672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Objective To develop a harmonized multicenter clinical and electroencephalography (EEG) database for acute hypoxic-ischemic brain injury research involving patients with cardiac arrest. Design Multicenter cohort, partly prospective and partly retrospective. Setting Seven academic or teaching hospitals from the U.S. and Europe. Patients Individuals aged 16 or older who were comatose after return of spontaneous circulation following a cardiac arrest who had continuous EEG monitoring were included. Interventions not applicable. Measurements and Main Results Clinical and EEG data were harmonized and stored in a common Waveform Database (WFDB)-compatible format. Automated spike frequency, background continuity, and artifact detection on EEG were calculated with 10 second resolution and summarized hourly. Neurological outcome was determined at 3-6 months using the best Cerebral Performance Category (CPC) scale. This database includes clinical and 56,676 hours (3.9 TB) of continuous EEG data for 1,020 patients. Most patients died (N=603, 59%), 48 (5%) had severe neurological disability (CPC 3 or 4), and 369 (36%) had good functional recovery (CPC 1-2). There is significant variability in mean EEG recording duration depending on the neurological outcome (range 53-102h for CPC 1 and CPC 4, respectively). Epileptiform activity averaging 1 Hz or more in frequency for at least one hour was seen in 258 (25%) patients (19% for CPC 1-2 and 29% for CPC 3-5). Burst suppression was observed for at least one hour in 207 (56%) and 635 (97%) patients with CPC 1-2 and CPC 3-5, respectively. Conclusions The International Cardiac Arrest Research (I-CARE) consortium database provides a comprehensive real-world clinical and EEG dataset for neurophysiology research of comatose patients after cardiac arrest. This dataset covers the spectrum of abnormal EEG patterns after cardiac arrest, including epileptiform patterns and those in the ictal-interictal continuum.
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Affiliation(s)
- Edilberto Amorim
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wei-Long Zheng
- Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, CN
| | - Mohammad M. Ghassemi
- Department of Computer Science and Engineering, Michigan State University, East Lansing, Michigan, USA
| | - Mahsa Aghaeeaval
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Pravinkumar Kandhare
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Vishnu Karukonda
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California, USA
| | - Jong Woo Lee
- Department of Neurology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Susan T. Herman
- Department of Neurology, Barrow Neurological Institute, Comprehensive Epilepsy Center, Phoenix, Arizona, USA
| | - Adithya Sivaraju
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nicolas Gaspard
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Neurology, Universite Libre de Bruxelles, Brussels, Belgium
| | - Jeannette Hofmeijer
- Clinical Neurophysiology Group, University of Twente, Enschede, The Netherlands
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Michel J. A. M. van Putten
- Clinical Neurophysiology Group, University of Twente, Enschede, The Netherlands
- Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, The Netherlands
| | - Reza Sameni
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Matthew A. Reyna
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, USA
| | - M. Brandon Westover
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Merritt SH, Gaffuri K, Zak PJ. Accurately predicting hit songs using neurophysiology and machine learning. Front Artif Intell 2023; 6:1154663. [PMID: 37408542 PMCID: PMC10318137 DOI: 10.3389/frai.2023.1154663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/09/2023] [Indexed: 07/07/2023] Open
Abstract
Identifying hit songs is notoriously difficult. Traditionally, song elements have been measured from large databases to identify the lyrical aspects of hits. We took a different methodological approach, measuring neurophysiologic responses to a set of songs provided by a streaming music service that identified hits and flops. We compared several statistical approaches to examine the predictive accuracy of each technique. A linear statistical model using two neural measures identified hits with 69% accuracy. Then, we created a synthetic set data and applied ensemble machine learning to capture inherent non-linearities in neural data. This model classified hit songs with 97% accuracy. Applying machine learning to the neural response to 1st min of songs accurately classified hits 82% of the time showing that the brain rapidly identifies hit music. Our results demonstrate that applying machine learning to neural data can substantially increase classification accuracy for difficult to predict market outcomes.
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Affiliation(s)
- Sean H. Merritt
- Center for Neuroeconomics Studies, Claremont Graduate University, Claremont, CA, United States
| | - Kevin Gaffuri
- Center for Neuroeconomics Studies, Claremont Graduate University, Claremont, CA, United States
| | - Paul J. Zak
- Center for Neuroeconomics Studies, Claremont Graduate University, Claremont, CA, United States
- Immersion Neuroscience, Henderson, NV, United States
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Lee DA, Park KM, Kim HC, Khoo CS, Lee BI, Kim SE. Spectrum of Ictal-Interictal Continuum: The Significance of 2HELPS2B Score and Background Suppression. J Clin Neurophysiol 2023; 40:364-370. [PMID: 34510091 DOI: 10.1097/wnp.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The aims of this study were to identify (1) the spectrum of ictal-interictal continuum (IIC) using the two dimensions of 2HELPS2B score and background suppression and (2) the response to subsequent anti-seizure drugs depends on the spectrum of IIC. METHODS The study prospectively enrolled 62 patients with IIC on EEG. The diagnosis of nonconvulsive status epilepticus was attempted with Salzburg criteria as well as clinical and neuroimaging data. IICs were dichotomized into patients with nonconvulsive status epilepticus and coma-IIC. The 2HELPS2B score was evaluated as the original proposal. The suppression ratio was analyzed with Persyst software. RESULTS Forty-seven cases (75.8%) were nonconvulsive status epilepticus-IIC and 15 cases (24.2%) were coma-IIC. Multivariate analysis revealed that the 2HELPS2B score was the only significant variable dichotomizing the spectrum of IIC (odds ratio, 3.0; 95% confidence interval, 1.06-8.6; P = 0.03 for nonconvulsive status epilepticus-IIC). In addition, the suppression ratio was significantly negatively correlated with 2HELPS2B scores (Spearman coefficient = -0.37, P = 0.004 for left hemisphere and Spearman coefficient = -0.3, P = 0.02 for right hemisphere). Furthermore, patients with higher 2HELPS2B score (74% [14/19] in ≥2 points vs. 44% [14/32] in <2 points, P = 0.03 by χ 2 test) and lower suppression ratio (62% [23/37] in ≤2.18 vs. 35% [6/17] in >2.18, P = 0.06 by χ 2 test) seemed to be more responsive to subsequent anti-seizure drug. CONCLUSIONS The 2HELPS2B score and background suppression can be used to distinguish the spectrum of IIC and thereby predict the response to subsequent anti-seizure drug.
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Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Hyung Chan Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ching Soong Khoo
- Neurology Unit, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia ; and
| | - Byung In Lee
- Department of Neurology, CHA Ilsan Medical Center, Ilsan, Republic of Korea
| | - Sung Eun Kim
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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14
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Zhao G, Feng G, Zhao L, Feng S, An Y, Kong C, Wang T. Application of quantitative electroencephalography in predicting early cerebral ischemia in patients undergoing carotid endarterectomy. Front Neurol 2023; 14:1159788. [PMID: 37090976 PMCID: PMC10117753 DOI: 10.3389/fneur.2023.1159788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundQuantitative electroencephalography (QEEG) has emerged as a promising monitoring method in cerebral ischemia, but the feasibility of QEEG in intraoperative cerebral perfusion-related ischemia monitoring is still uncertain. The purpose of this study was to investigate the value of QEEG monitoring in Carotid Endarterectomy (CEA) and the thresholds for intraoperative cerebral perfusion-related ischemia monitoring.MethodsSixty-three patients who underwent carotid endarterectomy with continuous Transcranial Doppler ultrasound (TCD) monitoring and QEEG monitoring at Xuanwu Hospital Capital Medical University from January 2021 to August 2021 were enrolled in this study. Each patient received total intravenous anesthesia. Middle cerebral artery blood flow velocity (V-MCA) was obtained by TCD. Relative alpha percentage (RA) and alpha-delta ratio (ADR) were obtained by QEEG monitoring. Patients were divided into ischemic and non-ischemic groups using a decline of more than 50% in the V-MCA monitored by TCD as the gold standard.ResultsOf the 63 patients, twenty patients were divided into the ischemic group, and forty-three patients into the non-ischemic group. Ipsilateral post-clamp RA and ADR values of QEEG were decreased for all patients in the ischemic group. The optimal threshold for RA and ADR to predict cerebral ischemia was a 14% decrease from baseline (sensitivity 90.0%, specificity 90.7%, Kappa value 0.786), a 21% decrease from baseline (sensitivity 85.0%, specificity 81.4%, Kappa value 0.622), respectively, indicated by TCD monitoring.ConclusionsOur study demonstrated that QEEG is a promising monitoring method undergoing CEA under general anesthesia and has good consistency with TCD.
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15
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Elmer J, Kurz MC, Coppler PJ, Steinberg A, DeMasi S, De-Arteaga M, Simon N, Zadorozny VI, Flickinger KL, Callaway CW. Time to Awakening and Self-Fulfilling Prophecies After Cardiac Arrest. Crit Care Med 2023; 51:503-512. [PMID: 36752628 PMCID: PMC10023349 DOI: 10.1097/ccm.0000000000005790] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES Withdrawal of life-sustaining therapies for perceived poor neurologic prognosis (WLST-N) is common after resuscitation from cardiac arrest and may bias outcome estimates from models trained using observational data. We compared several approaches to outcome prediction with the goal of identifying strategies to quantify and reduce this bias. DESIGN Retrospective observational cohort study. SETTING Two academic medical centers ("UPMC" and "University of Alabama Birmingham" [UAB]). PATIENTS Comatose adults resuscitated from cardiac arrest. INTERVENTION None. MEASUREMENTS AND MAIN RESULTS As potential predictors, we considered clinical, laboratory, imaging, and quantitative electroencephalography data available early after hospital arrival. We followed patients until death, discharge, or awakening from coma. We used penalized Cox regression with a least absolute shrinkage and selection operator penalty and five-fold cross-validation to predict time to awakening in UPMC patients and then externally validated the model in UAB patients. This model censored patients after WLST-N, considering subsequent potential for awakening to be unknown. Next, we developed a penalized logistic model predicting awakening, which treated failure to awaken after WLST-N as a true observed outcome, and a separate logistic model predicting WLST-N. We scaled and centered individual patients' Cox and logistic predictions for awakening to allow direct comparison and then explored the difference in predictions across probabilities of WLST-N. Overall, 1,254 patients were included, and 29% awakened. Cox models performed well (mean area under the curve was 0.93 in the UPMC test sets and 0.83 in external validation). Logistic predictions of awakening were systematically more pessimistic than Cox-based predictions for patients at higher risk of WLST-N, suggesting potential for self-fulfilling prophecies to arise when failure to awaken after WLST-N is considered as the ground truth outcome. CONCLUSIONS Compared with traditional binary outcome prediction, censoring outcomes after WLST-N may reduce potential for bias and self-fulfilling prophecies.
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Affiliation(s)
- Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama-Birmingham Birmingham Alabama USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama-Birmingham Birmingham Alabama USA
- Center for Injury Science, University of Alabama-Birmingham Birmingham Alabama USA
| | - Patrick J Coppler
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Alexis Steinberg
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Stephanie DeMasi
- Department of Emergency Medicine, Virginia Comonwealth University, Richmond, Virginia, USA
| | - Maria De-Arteaga
- Information, Risk and Operations Management Department, McCombs School of Business, University of Texas at Austin, Austin, TX USA
| | - Noah Simon
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA USA
| | | | - Katharyn L. Flickinger
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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16
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Viderman D, Abdildin YG, Batkuldinova K, Badenes R, Bilotta F. Artificial Intelligence in Resuscitation: A Scoping Review. J Clin Med 2023; 12:jcm12062254. [PMID: 36983255 PMCID: PMC10054374 DOI: 10.3390/jcm12062254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/17/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction: Cardiac arrest is a significant cause of premature mortality and severe disability. Despite the death rate steadily decreasing over the previous decade, only 22% of survivors achieve good clinical status and only 25% of patients survive until their discharge from the hospital. The objective of this scoping review was to review relevant AI modalities and the main potential applications of AI in resuscitation. Methods: We conducted the literature search for related studies in PubMed, EMBASE, and Google Scholar. We included peer-reviewed publications and articles in the press, pooling and characterizing the data by their model types, goals, and benefits. Results: After identifying 268 original studies, we chose 59 original studies (reporting 1,817,419 patients) to include in the qualitative synthesis. AI-based methods appear to be superior to traditional methods in achieving high-level performance. Conclusion: AI might be useful in predicting cardiac arrest, heart rhythm disorders, and post-cardiac arrest outcomes, as well as in the delivery of drone-delivered defibrillators and notification of dispatchers. AI-powered technologies could be valuable assistants to continuously track patient conditions. Healthcare professionals should assist in the research and development of AI-powered technologies as well as their implementation into clinical practice.
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Affiliation(s)
- Dmitriy Viderman
- Department of Surgery, Nazarbayev University School of Medicine (NUSOM), Kerei, Zhanibek khandar Str. 5/1, Astana 010000, Kazakhstan;
| | - Yerkin G. Abdildin
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan
| | - Kamila Batkuldinova
- Department of Mechanical and Aerospace Engineering, School of Engineering and Digital Sciences, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan
| | - Rafael Badenes
- Department of Anaesthesiology and Intensive Care, Hospital Clìnico Universitario de Valencia, University of Valencia, 46001 Valencia, Spain
- Correspondence:
| | - Federico Bilotta
- Department of Anesthesia and Intensive Care, University La Sapienza, 00185 Rome, Italy
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Benghanem S, Pruvost-Robieux E, Bouchereau E, Gavaret M, Cariou A. Prognostication after cardiac arrest: how EEG and evoked potentials may improve the challenge. Ann Intensive Care 2022; 12:111. [PMID: 36480063 PMCID: PMC9732180 DOI: 10.1186/s13613-022-01083-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
About 80% of patients resuscitated from CA are comatose at ICU admission and nearly 50% of survivors are still unawake at 72 h. Predicting neurological outcome of these patients is important to provide correct information to patient's relatives, avoid disproportionate care in patients with irreversible hypoxic-ischemic brain injury (HIBI) and inappropriate withdrawal of care in patients with a possible favorable neurological recovery. ERC/ESICM 2021 algorithm allows a classification as "poor outcome likely" in 32%, the outcome remaining "indeterminate" in 68%. The crucial question is to know how we could improve the assessment of both unfavorable but also favorable outcome prediction. Neurophysiological tests, i.e., electroencephalography (EEG) and evoked-potentials (EPs) are a non-invasive bedside investigations. The EEG is the record of brain electrical fields, characterized by a high temporal resolution but a low spatial resolution. EEG is largely available, and represented the most widely tool use in recent survey examining current neuro-prognostication practices. The severity of HIBI is correlated with the predominant frequency and background continuity of EEG leading to "highly malignant" patterns as suppression or burst suppression in the most severe HIBI. EPs differ from EEG signals as they are stimulus induced and represent the summated activities of large populations of neurons firing in synchrony, requiring the average of numerous stimulations. Different EPs (i.e., somato sensory EPs (SSEPs), brainstem auditory EPs (BAEPs), middle latency auditory EPs (MLAEPs) and long latency event-related potentials (ERPs) with mismatch negativity (MMN) and P300 responses) can be assessed in ICU, with different brain generators and prognostic values. In the present review, we summarize EEG and EPs signal generators, recording modalities, interpretation and prognostic values of these different neurophysiological tools. Finally, we assess the perspective for futures neurophysiological investigations, aiming to reduce prognostic uncertainty in comatose and disorders of consciousness (DoC) patients after CA.
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Affiliation(s)
- Sarah Benghanem
- grid.411784.f0000 0001 0274 3893Medical ICU, Cochin Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,After ROSC Network, Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Estelle Pruvost-Robieux
- grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,Neurophysiology and Epileptology Department, GHU Psychiatry and Neurosciences, Sainte Anne, 75014 Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Eléonore Bouchereau
- Department of Neurocritical Care, G.H.U Paris Psychiatry and Neurosciences, 1, Rue Cabanis, 75014 Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Martine Gavaret
- grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,Neurophysiology and Epileptology Department, GHU Psychiatry and Neurosciences, Sainte Anne, 75014 Paris, France ,grid.7429.80000000121866389UMR 1266, Institut de Psychiatrie et, INSERM FHU NeuroVascNeurosciences de Paris-IPNP, 75014 Paris, France
| | - Alain Cariou
- grid.411784.f0000 0001 0274 3893Medical ICU, Cochin Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France ,grid.508487.60000 0004 7885 7602Medical School, University Paris Cité, Paris, France ,After ROSC Network, Paris, France ,grid.462416.30000 0004 0495 1460Paris-Cardiovascular-Research-Center (Sudden-Death-Expertise-Center), INSERM U970, Paris, France
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18
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A Simplified Electroencephalography Montage and Interpretation for Evaluation of Comatose Patients in the ICU. Crit Care Explor 2022; 4:e0781. [DOI: 10.1097/cce.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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19
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Hwang J, Cho SM, Ritzl EK. Recent applications of quantitative electroencephalography in adult intensive care units: a comprehensive review. J Neurol 2022; 269:6290-6309. [DOI: 10.1007/s00415-022-11337-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
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20
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Johnsen B, Jeppesen J, Duez CHV. Common patterns of EEG reactivity in post-anoxic coma identified by quantitative analyses. Clin Neurophysiol 2022; 142:143-153. [PMID: 36041343 DOI: 10.1016/j.clinph.2022.07.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/23/2022] [Accepted: 07/28/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Description of typical kinds of EEG reactivity (EEG-R) in post-anoxic coma using a quantitative method. METHODS Study of 101 out-of-hospital cardiac arrest patients, 71 with good outcome (cerebral performance category scale ≤ 2). EEG was recorded 12-24 hours after cardiac arrest and four noxious, one auditory, and one visual stimulation were applied for 30 seconds each. Individual reference intervals for the power in the delta, theta, alpha, and beta bands were calculated based on six 2-second resting epochs just prior to stimulations. EEG-R in consecutive 2-second epochs after stimulation was expressed in Z-scores. RESULTS EEG-R occurred roughly equally frequent as an increase or as a decrease in EEG activity. Sternal rub and sound stimulation were most provocative with the most pronounced changes as an increase in delta activity 4.5-8.5 seconds after stimulation and a decrease in theta activity 0.5-4.5 seconds after stimulation. These parameters predicted good outcome with an AUC of 0.852 (95 % CI: 0.771-0.932). CONCLUSIONS Quantitative EEG-R is a feasible method for identification of common types of reactivity, for evaluation of stimulation methods, and for prognostication. SIGNIFICANCE This method provides an objective measure of EEG-R revealing knowledge about the nature of EEG-R and its use as a diagnostic tool.
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Affiliation(s)
- Birger Johnsen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Jesper Jeppesen
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Liuzzi P, Magliacano A, De Bellis F, Mannini A, Estraneo A. Predicting outcome of patients with prolonged disorders of consciousness using machine learning models based on medical complexity. Sci Rep 2022; 12:13471. [PMID: 35931703 PMCID: PMC9356130 DOI: 10.1038/s41598-022-17561-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/27/2022] [Indexed: 12/25/2022] Open
Abstract
Patients with severe acquired brain injury and prolonged disorders of consciousness (pDoC) are characterized by high clinical complexity and high risk to develop medical complications. The present multi-center longitudinal study aimed at investigating the impact of medical complications on the prediction of clinical outcome by means of machine learning models. Patients with pDoC were consecutively enrolled at admission in 23 intensive neurorehabilitation units (IRU) and followed-up at 6 months from onset via the Glasgow Outcome Scale-Extended (GOSE). Demographic and clinical data at study entry and medical complications developed within 3 months from admission were collected. Machine learning models were developed, targeting neurological outcomes at 6 months from brain injury using data collected at admission. Then, after concatenating predictions of such models to the medical complications collected within 3 months, a cascade model was developed. One hundred seventy six patients with pDoC (M: 123, median age 60.2 years) were included in the analysis. At admission, the best performing solution (k-Nearest Neighbors regression, KNN) resulted in a median validation error of 0.59 points [IQR 0.14] and a classification accuracy of dichotomized GOS-E of 88.6%. Coherently, at 3 months, the best model resulted in a median validation error of 0.49 points [IQR 0.11] and a classification accuracy of 92.6%. Interpreting the admission KNN showed how the negative effect of older age is strengthened when patients' communication levels are high and ameliorated when no communication is present. The model trained at 3 months showed appropriate adaptation of the admission prediction according to the severity of the developed medical complexity in the first 3 months. In this work, we developed and cross-validated an interpretable decision support tool capable of distinguishing patients which will reach sufficient independence levels at 6 months (GOS-E > 4). Furthermore, we provide an updated prediction at 3 months, keeping in consideration the rehabilitative path and the risen medical complexity.
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Affiliation(s)
- Piergiuseppe Liuzzi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Florence, Italy.,Scuola Superiore Sant'Anna, Istituto di BioRobotica, Viale Rinaldo Piaggio 34, Pontedera, Italy
| | - Alfonso Magliacano
- Fondazione Don Carlo Gnocchi ONLUS, Scientific Institute for Research and Health Care, Via Quadrivio, Sant'Angelo dei Lombardi, Italy
| | - Francesco De Bellis
- Fondazione Don Carlo Gnocchi ONLUS, Scientific Institute for Research and Health Care, Via Quadrivio, Sant'Angelo dei Lombardi, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via di Scandicci 269, Florence, Italy.
| | - Anna Estraneo
- Fondazione Don Carlo Gnocchi ONLUS, Scientific Institute for Research and Health Care, Via Quadrivio, Sant'Angelo dei Lombardi, Italy.,Unità di Neurologia, Santa Maria della Pietà General Hospital, Via della Repubblica 7, Nola, Italy
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22
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Tian J, Zhou Y, Liu H, Qu Z, Zhang L, Liu L. Quantitative EEG parameters can improve the predictive value of the non-traumatic neurological ICU patient prognosis through the machine learning method. Front Neurol 2022; 13:897734. [PMID: 35968284 PMCID: PMC9366714 DOI: 10.3389/fneur.2022.897734] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/04/2022] [Indexed: 12/04/2022] Open
Abstract
Background Better outcome prediction could assist in reliable classification of the illnesses in neurological intensive care unit (ICU) severity to support clinical decision-making. We developed a multifactorial model including quantitative electroencephalography (QEEG) parameters for outcome prediction of patients in neurological ICU. Methods We retrospectively analyzed neurological ICU patients from November 2018 to November 2021. We used 3-month mortality as the outcome. Prediction models were created using a linear discriminant analysis (LDA) based on QEEG parameters, APACHEII score, and clinically relevant features. Additionally, we compared our best models with APACHEII score and Glasgow Coma Scale (GCS). The DeLong test was carried out to compare the ROC curves in different models. Results A total of 110 patients were included and divided into a training set (n=80) and a validation set (n = 30). The best performing model had an AUC of 0.85 in the training set and an AUC of 0.82 in the validation set, which were better than that of GCS (training set 0.64, validation set 0.61). Models in which we selected only the 4 best QEEG parameters had an AUC of 0.77 in the training set and an AUC of 0.71 in the validation set, which were similar to that of APACHEII (training set 0.75, validation set 0.73). The models also identified the relative importance of each feature. Conclusion Multifactorial machine learning models using QEEG parameters, clinical data, and APACHEII score have a better potential to predict 3-month mortality in non-traumatic patients in neurological ICU.
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Affiliation(s)
- Jia Tian
- Neurocritical Care Unit, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yi Zhou
- Neurocritical Care Unit, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hu Liu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhenzhen Qu
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Limiao Zhang
- Neurocritical Care Unit, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lidou Liu
- Neurocritical Care Unit, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Lidou Liu
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Shi X, Gu Q, Li Y, Diao M, Wen X, Hu W, Xi S. A Standardized Multimodal Neurological Monitoring Protocol-Guided Cerebral Protection Therapy for Venoarterial Extracorporeal Membrane Oxygenation Supported Patients. Front Med (Lausanne) 2022; 9:922355. [PMID: 35814786 PMCID: PMC9261463 DOI: 10.3389/fmed.2022.922355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background The main objective of this study was to investigate the role of a multimodal neurological monitoring (MNM)-guided protocol in the precision identification of neural impairment and long-term neurological outcomes in venoarterial extracorporeal membrane oxygenation (VA-ECMO) supported patients. Methods We performed a cohort study that examined adult patients who underwent VA-ECMO support in our center between February 2010 and April 2021. These patients were retrospectively assigned to the “with MNM group” and the “without MNM group” based on the presence or absence of MNM-guided precision management. The differences in ECMO-related characteristics, evaluation indicators (precision, sensitivity, and specificity) of the MNM-guided protocol, and the long-term outcomes of the surviving patients were measured and compared between the two groups. Results A total of 63 patients with VA-ECMO support were retrospectively assigned to the without MNM group (n = 35) and the with MNM group (n = 28). The incidence of neural impairment in the without MNM group was significantly higher than that in the with MNM group (82.1 vs. 54.3%, P = 0.020). The MNM group exhibited older median ages [52.5 (39.5, 65.3) vs. 31 (26.5, 48.0), P = 0.008], a higher success rate of ECMO weaning (92.8 vs. 71.4%, P = 0.047), and a lower median duration of building ECMO [40.0 (35.0, 52.0) vs. 58.0 (48.0, 76.0), P = 0.025] and median ECMO duration days [5.0 (4.0, 6.2) vs. 7.0 (5.0, 10.5), P = 0.018] than the group without MNM. The MNM-guided protocol exhibited a higher precision rate (82.1 vs. 60.0%), sensitivity (95.7 vs. 78.9%), and specificity (83.3 vs. 37.5%) in identifying neural impairment in VA-ECMO support patients. There were significant differences in the long-term outcomes of survivors at 1, 3 and 6 months after discharge between the two groups (P < 0.05). However, the results showed no significant differences in ICU length of stay (LOS), hospital LOS, survival to discharge, or 28-day mortality between the two groups (P > 0.05). Conclusion The MNM-guided protocol is conducive to guiding intensivists in the improvement of cerebral protection therapy for ECMO-supported patients to detect and treat potential neurologic impairment promptly, and then improving long-term neurological outcomes after discharge.
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Affiliation(s)
- Xiaobei Shi
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qiao Gu
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yiwei Li
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengyuan Diao
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin Wen
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Hu
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Wei Hu
| | - Shaosong Xi
- Department of Critical Care Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Shaosong Xi
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Huang Y, Deng Y, Zhang R, Meng M, Chen D. Comparing the Effect of Dexmedetomidine and Midazolam in Patients with Brain Injury. Brain Sci 2022; 12:brainsci12060752. [PMID: 35741637 PMCID: PMC9221420 DOI: 10.3390/brainsci12060752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies have shown that dexmedetomidine improves neurological function. Whether dexmedetomidine reduces mortality or improves quantitative electroencephalography (qEEG) among patients post-craniotomy remains unclear. METHODS This single-center randomized study was conducted prospectively from 1 January 2019 to 31 December 2020. Patients who were transferred to the ICU after craniotomy within 24 h were included. The analgesic was titrated to a Critical care Pain Observation Tool (CPOT) score ≤2, and the sedative was titrated to a Richmond Agitation-Sedation Scale (RASS) score ≤-3 for at least 24 h. The qEEG signals were collected by four electrodes (F3, T3, F4, and T4 according to the international 10/20 EEG electrode practice). The primary outcome was 28-day mortality and qEEG results on day 1 and day 3 after sedation. RESULTS One hundred and fifty-one patients were enrolled in this study, of whom 77 were in the dexmedetomidine group and 74 in the midazolam group. No significant difference was found between the two groups in mortality at 28 days (14.3% vs. 24.3%; p = 0.117) as well as in the theta/beta ratio (TBR), the delta/alpha ratio (DAR), and the (delta + theta)/(alpha + beta) ratio (DTABR) between the two groups on day 1 or day 3. However, both the TBR and the DTABR were significantly increased in the dexmedetomidine group. The DTABR in the midazolam group was significantly increased. The DAR was significantly increased on the right side in the dexmedetomidine group (20.4 (11.6-43.3) vs. 35.1 (16.7-65.0), p = 0.006) as well as on both sides in the midazolam group (Left: 19.5 (10.1-35.8) vs. 37.3 (19.3-75.7), p = 0.006; Right: 18.9 (10.1-52.3) vs. 39.8 (17.5-99.9), p = 0.002). CONCLUSION Compared with midazolam, dexmedetomidine did not lead to a lower 28-day mortality or better qEEG results in brain injury patients after a craniotomy.
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Outcome Prediction of Postanoxic Coma: A Comparison of Automated Electroencephalography Analysis Methods. Neurocrit Care 2022; 37:248-258. [PMID: 35233717 PMCID: PMC9343315 DOI: 10.1007/s12028-022-01449-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/10/2022] [Indexed: 12/03/2022]
Abstract
Background To compare three computer-assisted quantitative electroencephalography (EEG) prediction models for the outcome prediction of comatose patients after cardiac arrest regarding predictive performance and robustness to artifacts. Methods A total of 871 continuous EEGs recorded up to 3 days after cardiac arrest in intensive care units of five teaching hospitals in the Netherlands were retrospectively analyzed. Outcome at 6 months was dichotomized as “good” (Cerebral Performance Category 1–2) or “poor” (Cerebral Performance Category 3–5). Three prediction models were implemented: a logistic regression model using two quantitative features, a random forest model with nine features, and a deep learning model based on a convolutional neural network. Data from two centers were used for training and fivefold cross-validation (n = 663), and data from three other centers were used for external validation (n = 208). Model output was the probability of good outcome. Predictive performances were evaluated by using receiver operating characteristic analysis and the calculation of predictive values. Robustness to artifacts was evaluated by using an artifact rejection algorithm, manually added noise, and randomly flattened channels in the EEG. Results The deep learning network showed the best overall predictive performance. On the external test set, poor outcome could be predicted by the deep learning network at 24 h with a sensitivity of 54% (95% confidence interval [CI] 44–64%) at a false positive rate (FPR) of 0% (95% CI 0–2%), significantly higher than the logistic regression (sensitivity 33%, FPR 0%) and random forest models (sensitivity 13%, FPR, 0%) (p < 0.05). Good outcome at 12 h could be predicted by the deep learning network with a sensitivity of 78% (95% CI 52–100%) at a FPR of 12% (95% CI 0–24%) and by the logistic regression model with a sensitivity of 83% (95% CI 83–83%) at a FPR of 3% (95% CI 3–3%), both significantly higher than the random forest model (sensitivity 1%, FPR 0%) (p < 0.05). The results of the deep learning network were the least affected by the presence of artifacts, added white noise, and flat EEG channels. Conclusions A deep learning model outperformed logistic regression and random forest models for reliable, robust, EEG-based outcome prediction of comatose patients after cardiac arrest.
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Mohamed M, Alamri A, Mohamed M, Khalid N, O'Halloran P, Staartjes V, Uff C. Prognosticating outcome using magnetic resonance imaging in patients with moderate to severe traumatic brain injury: a machine learning approach. Brain Inj 2022; 36:353-358. [PMID: 35129403 DOI: 10.1080/02699052.2022.2034184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Over the last decade advancements in computer processing have enabled the application of machine learning (ML) to complex medical problems. Convolutional neural networks (CNN), a type of ML, have been used to interrogate medical images for variety of purposes. In this study, we aimed to investigate the potential application of CNN in prognosticating patients with traumatic brain injury (TBI). METHODS Patients with moderate to severe TBI and evidence of diffuse axonal injury (DAI) were selected retrospectively. A CNN model was developed using a training subgroup and a holdout subgroup was used as a testing dataset. We reported the model characteristics including area under the receiver operating characteristic curve (AUC). RESULTS We included a total of 38 patient, of which we generated 725 MRI sections. We developed a CNN model based on a modified AlexNet architecture that interpreted the brain stem injury to generate outcome predictions. The model was able to predict GOS outcomes with a specificity of 0.43 and a sensitivity of 0.997. It showed an AUC of 0.917. CONCLUSION The utilization of machine learning MRI analysis for prognosticating patients with TBI is a valued method that require further investigation. This will require multicentre collaboration to generate large datasets.
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Affiliation(s)
- Moumin Mohamed
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - A Alamri
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - M Mohamed
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
| | - N Khalid
- Department of Neurosurgery, Royal London Hospital, London, UK
| | - Pj O'Halloran
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK.,Department of Physiology & Medical Physics, Royal College of Surgeons in Ireland, Ireland
| | - Ve Staartjes
- Clinical Neuroscience Department, Machine Intelligence in Clinical Neuroscience (Micn) Laboratory, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - C Uff
- Department of Neurosurgery, Royal London Hospital, London, UK.,Neurosurgery Department, The London Neuro-Machine Learning Institute, Barts Health NHS Trust, London, UK
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Bronder J, Cho SM, Geocadin RG, Ritzl EK. Revisiting EEG as part of the multidisciplinary approach to post-cardiac arrest care and prognostication: A review. Resusc Plus 2022; 9:100189. [PMID: 34988537 PMCID: PMC8693464 DOI: 10.1016/j.resplu.2021.100189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/01/2022] Open
Abstract
Since the 1960s, EEG has been used to assess the neurologic function of patients in the hours and days after cardiac arrest. Accurate and reliable prognostication after cardiac arrest is vital for tailoring aggressive patient care for those with a high likelihood of recovery and setting appropriate goals of care for those who have a high likelihood of a poor outcome. Attempts to define EEG's role in this process has evolved over the years. In this review, we provide important historical context about EEG's use, it's perceived unreliability in the post-cardiac arrest patient in the past and provide a detailed analysis of how this role has changed recently. A review of the 71 most recent and highest quality studies demonstrates that the introduction of a uniform classification and a timed approach to EEG analysis have positioned EEG as a complementary tool in the multimodal approach for prognostication. The review was created and intended for medical staff in the intensive care units and emphasizes EEG patterns and timing which portend both favorable and poor prognoses. Also, the review addresses the overall quality of the existing studies and discusses future directions to address the knowledge gaps in this field.
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Affiliation(s)
- Jay Bronder
- Epilepsy Fellow, Department of Neurology, Johns Hopkins Hospital, 600 N. Wolfe St / Meyer 2-147, Baltimore, MD 21287-7247, USA
| | - Sung-Min Cho
- Neuroscience Critical Care Division, Departments of Neurology, Neurosurgery, and Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD 21287, USA
| | - Romergryko G Geocadin
- Professor of Neurology, Anesthesiology-Critical Care, Neurosurgery, and Joint Appointment in Medicine, The Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Phipps 455, Baltimore, MD 21287, USA
| | - Eva Katharina Ritzl
- Department of Neurology and Anesthesia and Critical Care Medicine, Johns Hopkins Hospital, 1800 Orleans Street, Suite 3329, Baltimore, MD 21287, USA
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Zheng WL, Amorim E, Jing J, Wu O, Ghassemi M, Lee JW, Sivaraju A, Pang T, Herman ST, Gaspard N, Ruijter BJ, Tjepkema-Cloostermans MC, Hofmeijer J, van Putten MJAM, Westover MB. Predicting Neurological Outcome from Electroencephalogram Dynamics in Comatose Patients after Cardiac Arrest with Deep Learning. IEEE Trans Biomed Eng 2021; 69:1813-1825. [PMID: 34962860 PMCID: PMC9087641 DOI: 10.1109/tbme.2021.3139007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Most cardiac arrest patients who are successfully resuscitated are initially comatose due to hypoxic-ischemic brain injury. Quantitative electroencephalography (EEG) provides valuable prognostic information. However, prior approaches largely rely on snapshots of the EEG, without taking advantage of temporal information. METHODS We present a recurrent deep neural network with the goal of capturing temporal dynamics from longitudinal EEG data to predict long-term neurological outcomes. We utilized a large international dataset of continuous EEG recordings from 1,038 cardiac arrest patients from seven hospitals in Europe and the US. Poor outcome was defined as a Cerebral Performance Category (CPC) score of 3-5, and good outcome as CPC score 0-2 at 3 to 6-months after cardiac arrest. Model performance is evaluated using 5-fold cross validation. RESULTS The proposed approach provides predictions which improve over time, beginning from an area under the receiver operating characteristic curve (AUC-ROC) of 0.78 (95% CI: 0.72-0.81) at 12 hours, and reaching 0.88 (95% CI: 0.85-0.91) by 66 h after cardiac arrest. At 66 h, (sensitivity, specificity) points of interest on the ROC curve for predicting poor outcomes were (32,99)%, (55,95)%, and (62,90)%, (99,23)%, (95,47)%, and (90,62)%; whereas for predicting good outcome, the corresponding operating points were (17,99)%, (47,95)%, (62,90)%, (99,19)%, (95,48)%, (70,90)%. Moreover, the model provides predicted probabilities that closely match the observed frequencies of good and poor outcomes (calibration error 0.04). CONCLUSIONS AND SIGNIFICANCE These findings suggest that accounting for EEG trend information can substantially improve prediction of neurologic outcomes for patients with coma following cardiac arrest.
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Zheng WL, Amorim E, Jing J, Ge W, Hong S, Wu O, Ghassemi M, Lee JW, Sivaraju A, Pang T, Herman ST, Gaspard N, Ruijter BJ, Sun J, Tjepkema-Cloostermans MC, Hofmeijer J, van Putten MJAM, Westover MB. Predicting neurological outcome in comatose patients after cardiac arrest with multiscale deep neural networks. Resuscitation 2021; 169:86-94. [PMID: 34699925 PMCID: PMC8692444 DOI: 10.1016/j.resuscitation.2021.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Electroencephalography (EEG) is an important tool for neurological outcome prediction after cardiac arrest. However, the complexity of continuous EEG data limits timely and accurate interpretation by clinicians. We develop a deep neural network (DNN) model to leverage complex EEG trends for early and accurate assessment of cardiac arrest coma recovery likelihood. METHODS We developed a multiscale DNN combining convolutional neural networks (CNN) and recurrent neural networks (long short-term memory [LSTM]) using EEG and demographic information (age, gender, shockable rhythm) from a multicenter cohort of 1,038 cardiac arrest patients. The CNN learns EEG feature representations while the multiscale LSTM captures short-term and long-term EEG dynamics on multiple time scales. Poor outcome is defined as a Cerebral Performance Category (CPC) score of 3-5 and good outcome as CPC score 1-2 at 3-6 months after cardiac arrest. Performance is evaluated using area under the receiver operating characteristic curve (AUC) and calibration error. RESULTS Model performance increased with EEG duration, with AUC increasing from 0.83 (95% Confidence Interval [CI] 0.79-0.87 at 12h to 0.91 (95%CI 0.88-0.93) at 66h. Sensitivity of good and poor outcome prediction was 77% and 75% at a specificity of 90%, respectively. Sensitivity of poor outcome was 50% at a specificity of 99%. Predicted probability was well matched to the observation frequency of poor outcomes, with a calibration error of 0.11 [0.09-0.14]. CONCLUSIONS These results demonstrate that incorporating EEG evolution over time improves the accuracy of neurologic outcome prediction for patients with coma after cardiac arrest.
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Affiliation(s)
- Wei-Long Zheng
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Edilberto Amorim
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jin Jing
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Wendong Ge
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shenda Hong
- Department of Computer Science, University of Illinois at Urbana Champaign, Champaign, IL, USA
| | - Ona Wu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mohammad Ghassemi
- Department of Computer Science and Engineering, Michigan State University, East Lansing, MI, USA; Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jong Woo Lee
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Adithya Sivaraju
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Trudy Pang
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Nicolas Gaspard
- Department of Neurology, Université Libre de Bruxelles, Brussels, Belgium
| | - Barry J Ruijter
- Department of Clinical Neurophysiology, University of Twente, Enschede, the Netherlands
| | - Jimeng Sun
- Department of Computer Science, University of Illinois at Urbana Champaign, Champaign, IL, USA
| | - Marleen C Tjepkema-Cloostermans
- Departments of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jeannette Hofmeijer
- Department of Clinical Neurophysiology, University of Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Michel J A M van Putten
- Department of Clinical Neurophysiology, University of Twente, Enschede, the Netherlands; Departments of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - M Brandon Westover
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Hierarchical Cluster Analysis Identifies Distinct Physiological States After Acute Brain Injury. Neurocrit Care 2021; 36:630-639. [PMID: 34661861 DOI: 10.1007/s12028-021-01362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Analysis of intracranial multimodality monitoring data is challenging, and quantitative methods may help identify unique physiological signatures that inform therapeutic strategies and outcome prediction. The aim of this study was to test the hypothesis that data-driven approaches can identify distinct physiological states from intracranial multimodality monitoring data. METHODS This was a single-center retrospective observational study of patients with either severe traumatic brain injury or high-grade subarachnoid hemorrhage who underwent invasive multimodality neuromonitoring. We used hierarchical cluster analysis to group hourly values for heart rate, mean arterial pressure, intracranial pressure, brain tissue oxygen, and cerebral microdialysis across all included patients into distinct groups. Average values for measured physiological variables were compared across the identified clusters, and physiological profiles from identified clusters were mapped onto physiological states known to occur after acute brain injury. The distribution of clusters was compared between patients with favorable outcome (discharged to home or acute rehab) and unfavorable outcome (in-hospital death or discharged to chronic nursing facility). RESULTS A total of 1704 observations from 20 patients were included. Even though the difference in mean values for measured variables between patients with favorable and unfavorable outcome were small, we identified four distinct clusters within our data: (1) events with low brain tissue oxygen and high lactate-to-pyruvate ratio-values (consistent with cerebral ischemia), (2) events with higher intracranial pressure values without evidence for ischemia (3) events which appeared to be physiologically "normal," and (4) events with high cerebral lactate without brain hypoxia (consistent with cerebral hyperglycolysis). Patients with a favorable outcome had a greater proportion of cluster 3 (normal) events, whereas patients with an unfavorable outcome had a greater proportion of cluster 1 (ischemia) and cluster 4 (hyperglycolysis) events (p < 0.0001, Fisher-Freeman-Halton test). CONCLUSIONS A data-driven approach can identify distinct groupings from invasive multimodality neuromonitoring data that may have implications for therapeutic strategies and outcome predictions. These groupings could be used as classifiers to train machine learning models that can aid in the treatment of patients with acute brain injury. Further work is needed to replicate the findings of this exploratory study in larger data sets.
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31
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Horowitz JM, Owyang C, Perman SM, Mitchell OJL, Yuriditsky E, Sawyer KN, Blewer AL, Rittenberger JC, Ciullo A, Hsu CH, Kotini-Shah P, Johnson N, Morgan RW, Moskowitz A, Dainty KN, Fleitman J, Uzendu AI, Abella BS, Teran F. The Latest in Resuscitation Research: Highlights From the 2020 American Heart Association's Resuscitation Science Symposium. J Am Heart Assoc 2021; 10:e021575. [PMID: 34369175 PMCID: PMC8475047 DOI: 10.1161/jaha.121.021575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Clark Owyang
- Department of Emergency Medicine and Division of Pulmonary and Critical Care Medicine Weill Cornell Medicine New York City NY
| | - Sarah M Perman
- Department of Emergency Medicine University of Colorado School of Medicine Aurora CO
| | - Oscar J L Mitchell
- Division of Pulmonary and Critical Care Department of Medicine University of Pennsylvania Philadelphia PA
| | | | - Kelly N Sawyer
- Department of Emergency Medicine University of Pittsburgh School of Medicine Pittsburgh PA
| | - Audrey L Blewer
- Department of Family Medicine and Community Health Duke University Durham NC
| | - Jon C Rittenberger
- Guthrie-Robert Packer Hospital Emergency Medicine Residency Geisinger Commonwealth Medical College Sayre PA
| | - Anna Ciullo
- Division of Emergency Medicine Department of Surgery University of Utah Health Salt Lake City UT
| | - Cindy H Hsu
- Department of Emergency Medicine Department of Surgery Michigan Center for Integrative Research in Critical Care Michigan Medicine University of Michigan Ann Arbor MI
| | - Pavitra Kotini-Shah
- Department of Emergency Medicine University of Illinois College of Medicine at Chicago Chicago IL
| | - Nicholas Johnson
- Division of Pulmonary, Critical Care, & Sleep Medicine Department of Emergency Medicine University of Washington Seattle WA
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine at Children's Hospital of Philadelphia Philadelphia PA
| | - Ari Moskowitz
- Division of Critical Care Medicine Montefiore Medical Center Bronx, New York NY
| | - Katie N Dainty
- North York General Hospital University of Toronto Toronto Canada
| | - Jessica Fleitman
- Division of Cardiology University of Pennsylvania Philadelphia PA
| | - Anezi I Uzendu
- Division of Cardiology Massachusetts General Hospital Boston MA
| | - Benjamin S Abella
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
| | - Felipe Teran
- Department of Emergency Medicine Center for Resuscitation Science University of Pennsylvania Philadelphia PA
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32
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Admiraal MM, Ramos LA, Delgado Olabarriaga S, Marquering HA, Horn J, van Rootselaar AF. Quantitative analysis of EEG reactivity for neurological prognostication after cardiac arrest. Clin Neurophysiol 2021; 132:2240-2247. [PMID: 34315065 DOI: 10.1016/j.clinph.2021.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 04/06/2021] [Accepted: 07/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test whether 1) quantitative analysis of EEG reactivity (EEG-R) using machine learning (ML) is superior to visual analysis, and 2) combining quantitative analyses of EEG-R and EEG background pattern increases prognostic value for prediction of poor outcome after cardiac arrest (CA). METHODS Several types of ML models were trained with twelve quantitative features derived from EEG-R and EEG background data of 134 adult CA patients. Poor outcome was a Cerebral Performance Category score of 3-5 within 6 months. RESULTS The Random Forest (RF) trained on EEG-R showed the highest AUC of 83% (95-CI 80-86) of tested ML classifiers, predicting poor outcome with 46% sensitivity (95%-CI 40-51) and 89% specificity (95%-CI 86-92). Visual analysis of EEG-R had 80% sensitivity and 65% specificity. The RF was also the best classifier for EEG background (AUC 85%, 95%-CI 83-88) at 24 h after CA, with 62% sensitivity (95%-CI 57-67) and 84% specificity (95%-CI 79-88). Combining EEG-R and EEG background RF classifiers reduced the number of false positives. CONCLUSIONS Quantitative EEG-R using ML predicts poor outcome with higher specificity, but lower sensitivity compared to visual analysis of EEG-R, and is of some additional value to ML on EEG background data. SIGNIFICANCE Quantitative EEG-R using ML is a promising alternative to visual analysis and of some added value to ML on EEG background data.
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Affiliation(s)
- M M Admiraal
- Amsterdam UMC, University of Amsterdam, Department of Neurology/Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - L A Ramos
- Amsterdam UMC, University of Amsterdam, Department Biomedical Engineering & Physics, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, the Netherlands
| | - S Delgado Olabarriaga
- Amsterdam UMC, University of Amsterdam, Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam, the Netherlands
| | - H A Marquering
- Amsterdam UMC, University of Amsterdam, Department Biomedical Engineering & Physics, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - J Horn
- Amsterdam UMC, University of Amsterdam, Laboratory for Experimental Intensive Care and Anesthesiology, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Department of Intensive Care, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - A F van Rootselaar
- Amsterdam UMC, University of Amsterdam, Department of Neurology/Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, the Netherlands
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Artificial Intelligence Analysis of EEG Amplitude in Intensive Heart Care. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6284035. [PMID: 34306595 PMCID: PMC8272660 DOI: 10.1155/2021/6284035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 02/05/2023]
Abstract
This article first studied the morphological characteristics of the EEG for intensive cardiac care; that is, based on the analysis of the mechanism of disease diagnosis and treatment, a signal processing and machine learning model was constructed. Then, the methods of signal preprocessing, signal feature extraction, new neural network model structure, training mechanism, optimization algorithm, and efficiency are studied, and experimental verification is carried out for public data sets and clinical big data. Then, the principle of intensive cardiac monitoring, the mechanism of disease diagnosis, the types of arrhythmia, and the characteristics of the typical signal are studied, and the rhythm performance, individual variability, and neurophysiological basis of electrical signals in intensive cardiac monitoring are researched. Finally, the automatic signal recognition technology is studied. In order to improve the training speed and generalization ability, a multiclassification model based on Least Squares Twin Support Vector Machine (LS-TWIN-SVM) is proposed. The computational complexity of the classification model algorithm is compared, and intelligence is adopted. The optimization algorithm selects the parameters of the classifier and uses the EEG signal to simulate the model. Support Vector Machines and their improved algorithms have achieved the ultimum in shallow neural networks and have achieved good results in the classification and recognition of bioelectric signals. The LS-TWIN-SVM algorithm proposed in this paper has achieved good results in the classification and recognition of bioelectric signals. It can perform bioinformatics processing on intensive cardiac care EEG signals, systematically biometric information, diagnose diseases, the real-time detection, auxiliary diagnosis, and rehabilitation of patients.
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Abstract
PURPOSE OF REVIEW Recovery after severe brain injury is variable and challenging to accurately predict at the individual patient level. This review highlights new developments in clinical prognostication with a special focus on the prediction of consciousness and increasing reliance on methods from data science. RECENT FINDINGS Recent research has leveraged serum biomarkers, quantitative electroencephalography, MRI, and physiological time-series to build models for recovery prediction. The analysis of high-resolution data and the integration of features from different modalities can be approached with efficient computational techniques. SUMMARY Advances in neurophysiology and neuroimaging, in combination with computational methods, represent a novel paradigm for prediction of consciousness and functional recovery after severe brain injury. Research is needed to produce reliable, patient-level predictions that could meaningfully impact clinical decision making.
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. Postreanimationsbehandlung. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00892-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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36
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Kim YM, Jeung KW, Kim WY, Park YS, Oh JS, You YH, Lee DH, Chae MK, Jeong YJ, Kim MC, Ha EJ, Hwang KJ, Kim WS, Lee JM, Cha KC, Chung SP, Park JD, Kim HS, Lee MJ, Na SH, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 5. Post-cardiac arrest care. Clin Exp Emerg Med 2021; 8:S41-S64. [PMID: 34034449 PMCID: PMC8171174 DOI: 10.15441/ceem.21.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/07/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyung Woon Jeung
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Suk Oh
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yeon Ho You
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Minjung Kathy Chae
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Yoo Jin Jeong
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Min Chul Kim
- Department of Internal Medicine, Chonnam National University College of Medicine, Gwangju, Korea
| | - Eun Jin Ha
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung Jin Hwang
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jae Myung Lee
- Department of General Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - June Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Mi Jin Lee
- Department of Emergency Medicine, Kyoungbook University College of Medicine, Daegu, Korea
| | - Sang-Hoon Na
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - on behalf of the Steering Committee of 2020 Korean Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chonnam National University College of Medicine, Gwangju, Korea
- Department of Emergency Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Chungnam National University College of Medicine, Daejeon, Korea
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Ajou University College of Medicine, Suwon, Korea
- Department of Internal Medicine, Chonnam National University College of Medicine, Gwangju, Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of General Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Department of Emergency Medicine, Kyoungbook University College of Medicine, Daegu, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
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Neuromonitoring After Cardiac Arrest: Can Twenty-First Century Medicine Personalize Post Cardiac Arrest Care? Neurol Clin 2021; 39:273-292. [PMID: 33896519 DOI: 10.1016/j.ncl.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiac arrest survivors comprise a heterogeneous population, in which the etiology of arrest, systemic and neurologic comorbidities, and sequelae of post-cardiac arrest syndrome influence the severity of secondary brain injury. The degree of secondary neurologic injury can be modifiable and is influenced by factors that alter cerebral physiology. Neuromonitoring techniques provide tools for evaluating the evolution of physiologic variables over time. This article reviews the pathophysiology of hypoxic-ischemic brain injury, provides an overview of the neuromonitoring tools available to identify risk profiles for secondary brain injury, and highlights the importance of an individualized approach to post cardiac arrest care.
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38
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Olasveengen TM, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care. Intensive Care Med 2021; 47:369-421. [PMID: 33765189 PMCID: PMC7993077 DOI: 10.1007/s00134-021-06368-4] [Citation(s) in RCA: 417] [Impact Index Per Article: 139.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/08/2021] [Indexed: 12/13/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.
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Affiliation(s)
- Jerry P. Nolan
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL UK
- Royal United Hospital, Bath, BA1 3NG UK
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W. Böttiger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC), Université Catholique de Louvain, Brussels, Belgium
- Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, Room A108, Coventry, CV4 7AL UK
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Véronique R. M. Moulaert
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Markus B. Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB UK
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39
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Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, Nikolaou N, Mariero Olasveengen T, Skrifvars MB, Taccone F, Soar J. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 2021; 161:220-269. [PMID: 33773827 DOI: 10.1016/j.resuscitation.2021.02.012] [Citation(s) in RCA: 338] [Impact Index Per Article: 112.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation, and organ donation.
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Affiliation(s)
- Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry CV4 7AL, UK; Royal United Hospital, Bath, BA1 3NG, UK.
| | - Claudio Sandroni
- Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy; Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bernd W Böttiger
- University Hospital of Cologne, Kerpener Straße 62, D-50937 Cologne, Germany
| | - Alain Cariou
- Cochin University Hospital (APHP) and University of Paris (Medical School), Paris, France
| | - Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Department of Clinical Sciences, Anaesthesia and Intensive Care Medicine, Lund University, Skane University Hospital, Lund, Sweden
| | - Cornelia Genbrugge
- Acute Medicine Research Pole, Institute of Experimental and Clinical Research (IREC) Université Catholique de Louvain, Brussels, Belgium; Emergency Department, University Hospitals Saint-Luc, Brussels, Belgium
| | - Kirstie Haywood
- Warwick Research in Nursing, Room A108, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Gisela Lilja
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden
| | - Véronique R M Moulaert
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
| | - Nikolaos Nikolaou
- Cardiology Department, Konstantopouleio General Hospital, Athens, Greece
| | - Theresa Mariero Olasveengen
- Department of Anesthesiology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Markus B Skrifvars
- Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Finland
| | - Fabio Taccone
- Department of Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik, 808, 1070 Brussels, Belgium
| | - Jasmeet Soar
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
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40
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Vivaldi N, Caiola M, Solarana K, Ye M. Evaluating Performance of EEG Data-Driven Machine Learning for Traumatic Brain Injury Classification. IEEE Trans Biomed Eng 2021; 68:3205-3216. [PMID: 33635785 PMCID: PMC9513823 DOI: 10.1109/tbme.2021.3062502] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Objectives: Big data analytics can potentially benefit the assessment and management of complex neurological conditions by extracting information that is difficult to identify manually. In this study, we evaluated the performance of commonly used supervised machine learning algorithms in the classification of patients with traumatic brain injury (TBI) history from those with stroke history and/or normal EEG. Methods: Support vector machine (SVM) and K-nearest neighbors (KNN) models were generated with a diverse feature set from Temple EEG Corpus for both two-class classification of patients with TBI history from normal subjects and three-class classification of TBI, stroke and normal subjects. Results: For two-class classification, an accuracy of 0.94 was achieved in 10-fold cross validation (CV), and 0.76 in independent validation (IV). For three-class classification, 0.85 and 0.71 accuracy were reached in CV and IV respectively. Overall, linear discriminant analysis (LDA) feature selection and SVM models consistently performed well in both CV and IV and for both two-class and three-class classification. Compared to normal control, both TBI and stroke patients showed an overall reduction in coherence and relative PSD in delta frequency, and an increase in higher frequency (alpha, mu, beta and gamma) power. But stroke patients showed a greater degree of change and had additional global decrease in theta power. Conclusions: Our study suggests that EEG data-driven machine learning can be a useful tool for TBI classification. Significance: Our study provides preliminary evidence that EEG ML algorithm can potentially provide specificity to separate different neurological conditions.
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41
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Khazanova D, Douglas VC, Amorim E. A matter of timing: EEG monitoring for neurological prognostication after cardiac arrest in the era of targeted temperature management. Minerva Anestesiol 2021; 87:704-713. [PMID: 33591136 DOI: 10.23736/s0375-9393.21.14793-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Neuromonitoring with electroencephalography (EEG) is an essential tool in neurological prognostication post-cardiac arrest. EEG allows reliable and real-time assessment of early changes in background patterns, development of seizures and epileptiform activity, as well as testing for background reactivity to stimuli despite use of sedation or targeted temperature management. Delayed emergence of consciousness post-cardiac arrest is common, therefore longitudinal monitoring of EEG allows the detection of trends indicative of neurological improvement before coma recovery can be observed clinically. In this review, we summarize essential recent literature in EEG monitoring for neurological prognostication post-cardiac arrest in the context of targeted temperature management, with a particular focus on the importance of the evolution of EEG patterns in the first few days following resuscitation.
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Affiliation(s)
- Darya Khazanova
- Department of Neurology, University of California, San Francisco, CA, USA.,Division of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Vanja C Douglas
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Edilberto Amorim
- Department of Neurology, University of California, San Francisco, CA, USA - .,Division of Neurology, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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42
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Yang F, Elmer J, Zadorozhny VI. SmartPrognosis: Automatic ensemble classification for quantitative EEG analysis in patients resuscitated from cardiac arrest. Knowl Based Syst 2021. [DOI: 10.1016/j.knosys.2020.106579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Simpkins AN, Busl KM, Amorim E, Barnett-Tapia C, Cervenka MC, Dhakar MB, Etherton MR, Fung C, Griggs R, Holloway RG, Kelly AG, Khan IR, Lizarraga KJ, Madagan HG, Onweni CL, Mestre H, Rabinstein AA, Rubinos C, Dionisio-Santos DA, Youn TS, Merck LH, Maciel CB. Proceedings from the Neurotherapeutics Symposium on Neurological Emergencies: Shaping the Future of Neurocritical Care. Neurocrit Care 2020; 33:636-645. [PMID: 32959201 PMCID: PMC7736003 DOI: 10.1007/s12028-020-01085-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022]
Abstract
Effective treatment options for patients with life-threatening neurological disorders are limited. To address this unmet need, high-impact translational research is essential for the advancement and development of novel therapeutic approaches in neurocritical care. "The Neurotherapeutics Symposium 2019-Neurological Emergencies" conference, held in Rochester, New York, in June 2019, was designed to accelerate translation of neurocritical care research via transdisciplinary team science and diversity enhancement. Diversity excellence in the neuroscience workforce brings innovative and creative perspectives, and team science broadens the scientific approach by incorporating views from multiple stakeholders. Both are essential components needed to address complex scientific questions. Under represented minorities and women were involved in the organization of the conference and accounted for 30-40% of speakers, moderators, and attendees. Participants represented a diverse group of stakeholders committed to translational research. Topics discussed at the conference included acute ischemic and hemorrhagic strokes, neurogenic respiratory dysregulation, seizures and status epilepticus, brain telemetry, neuroprognostication, disorders of consciousness, and multimodal monitoring. In these proceedings, we summarize the topics covered at the conference and suggest the groundwork for future high-yield research in neurologic emergencies.
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Affiliation(s)
- Alexis N Simpkins
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, Room L3-100, 1149 Newell Drive, Gainesville, FL, 32611, USA.
| | - Katharina M Busl
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, Room L3-100, 1149 Newell Drive, Gainesville, FL, 32611, USA
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Edilberto Amorim
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Carolina Barnett-Tapia
- Ellen and Martin Prosserman Centre for Neuromuscular Disorders, Toronto General Hospital, Toronto, ON, Canada
| | - Mackenzie C Cervenka
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Monica B Dhakar
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Mark R Etherton
- J. Phillip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Celia Fung
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert Griggs
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert G Holloway
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Adam G Kelly
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Imad R Khan
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karlo J Lizarraga
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Hannah G Madagan
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, Room L3-100, 1149 Newell Drive, Gainesville, FL, 32611, USA
| | - Chidinma L Onweni
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Humberto Mestre
- Center for Translational Neuromedicine, Department of Neurosurgery, University of Rochester Medical Center, Rochester, USA
| | | | - Clio Rubinos
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | | | - Teddy S Youn
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Lisa H Merck
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Carolina B Maciel
- Department of Neurology, McKnight Brain Institute, University of Florida College of Medicine, Room L3-100, 1149 Newell Drive, Gainesville, FL, 32611, USA
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
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44
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Cronberg T, Greer DM, Lilja G, Moulaert V, Swindell P, Rossetti AO. Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation. Lancet Neurol 2020; 19:611-622. [PMID: 32562686 DOI: 10.1016/s1474-4422(20)30117-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 02/08/2023]
Abstract
More patients are surviving cardiac arrest than ever before; however, the burden now lies with estimating neurological prognoses in a large number of patients who were initially comatose, in whom the ultimate outcome is unclear. Neurologists, neurointensivists, and clinical neurophysiologists must accurately balance the concern that overly conservative prognostication could leave patients in a severely disabled state, with the possibility that inaccurately pessimistic prognostication could lead to the withdrawal of life-sustaining treatment in patients who might otherwise have a good functional outcome. Prognostic tools have improved greatly, including electrophysiological tests, neuroimaging, and chemical biomarkers. Conclusions about the prognosis should be delayed at least 72 h after arrest to allow for the clearance of sedative drugs. Cognitive impairments, emotional problems, and fatigue are common among patients who have survived cardiac arrest, and often go unrecognised despite being related to caregiver burden and a decreased participation in society. Through simple screening, these problems can be identified, and patients can be provided with adequate information and rehabilitation.
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Affiliation(s)
- Tobias Cronberg
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden.
| | - David M Greer
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Gisela Lilja
- Department of Clinical Sciences, Neurology, Lund University, Skane University Hospital, Lund, Sweden
| | - Véronique Moulaert
- Department of Rehabilitation Medicine, University of Groningen, University Medical Centre Groningen, Netherlands
| | | | - Andrea O Rossetti
- Department of Clinical Neurosciences, University Hospital and University of Lausanne, Lausanne, Switzerland
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Neurological Monitoring and Complications of Pediatric Extracorporeal Membrane Oxygenation Support. Pediatr Neurol 2020; 108:31-39. [PMID: 32299748 PMCID: PMC7698354 DOI: 10.1016/j.pediatrneurol.2020.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/17/2022]
Abstract
Extracorporeal membrane oxygenation is extracorporeal life support for life-threatening cardiopulmonary failure. Since its introduction, the use of extracorporeal membrane oxygenation has expanded to patients with more complex comorbidities without change in patient mortality rates. Although many patients survive, significant neurological complications like seizures, ischemic strokes, and intracranial hemorrhage can occur during extracorporeal membrane oxygenation care. The risks of these complications often add to the complexity of decision-making surrounding extracorporeal membrane oxygenation support. In this review, we discuss the pathophysiology and incidence of neurological complications in children supported on extracorporeal membrane oxygenation, factors influencing the incidence of these complications, commonly used neurological monitoring modalities, and outcomes for this complex patient population. We discuss the current literature on the use of electroencephalography for both seizure detection and monitoring of background electroencephalographic changes, in addition to the use of less commonly used imaging modalities like transcranial Doppler. We summarize the knowledge gaps and the lack of clinical consensus guidelines for managing these potentially life-changing neurological complications. Finally, we discuss future work to further understand the pathophysiology of extracorporeal membrane oxygenation-related neurological complications.
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Bhardwaj P, Yadav RK, Kurian S. Digitizing the Pharma Neurons - A Technological Operation in Progress! Rev Recent Clin Trials 2020; 15:178-187. [PMID: 32564760 DOI: 10.2174/1574887115666200621183459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/27/2020] [Accepted: 05/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Digitization and automation are the buzzwords in clinical research and pharma companies are investigating heavily here. Right from drug discovery to personalized medicine, digital patients and patient engagement, there is great consideration of technology at each step. METHODS The published data and online information available is reviewed to give an overview of digitization in pharma, across the drug development cycle, industry collaborations and innovations. The regulatory guidelines, innovative collaborations across industry, academics and thought leadership are presented. Also included are some ideas, suggestions, way forwards while digitizing the pharma neurons, the regulatory stand, benefits and challenges. RESULTS The innovations range from discovering personalized medicine to conducting virtual clinical trials, and maximizing data collection from the real-world experience. To address the increasing demand for the real-world data and the needs of tech-savvy patients, the innovations are shaping up accordingly. Pharma companies are collaborating with academics and they are co-innovating the technology for example Massachusetts Institute of Technology's program. This focuses on the modernization of clinical trials, strategic use of artificial intelligence and machine learning using real-world evidence, assess the risk-benefit ratio of deploying digital analytics in medicine, and proactively identifying the solutions. CONCLUSION With unfolding data on the impact of science and technology amalgamation, we need shared mindset between data scientists and medical professionals to maximize the utility of enormous health and medical data. To tackle this efficiently, there is a need of cross-collaboration and education, and align with ethical and regulatory requirements. A perfect blend of industry, regulatory, and academia will ensure successful digitization of pharma neurons.
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Affiliation(s)
| | - Raj Kumar Yadav
- Integral Health Clinic, Department of Physiology, All India Institute of Medical Sciences, New Delhi-110029, India
| | - Sojan Kurian
- Tata Consultancy Services, New York, NY, United States
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Quantitative EEG markers to prognosticate critically ill patients with COVID-19: A retrospective cohort study. Clin Neurophysiol 2020; 131:1824-1826. [PMID: 32544837 PMCID: PMC7274989 DOI: 10.1016/j.clinph.2020.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022]
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